Ask the GP: What's the best remedy for a flaky, itchy scalp?
Q: I'VE HAD psoriasis on my scalp for years and nothing helps it. My mother had it, and so do my two children and my brother. I know there's no cure but are there any new treatments or research?
A: PSORIASIS IS a chronic inflammatory disorder that typically causes a build-up of flaky patches on the skin - the result of a speeding up of the production of skin cells. It is thought to be due to a fault in the immune system.
The disease can have effects beyond the skin - around one in three of those with it develops a form of arthritis in the joints, for example. It can run in families (as in your case) but smoking, obesity and alcohol are also associated with a higher risk of developing it.
There is a wide spectrum of severity of the disease - I've seen patients with one scaly plaque the size of a 5p coin, hidden on the scalp, yet with others most of the body is affected.
I'm assuming that you have tried shampoos containing coal tar, which slows down the growth of new skin cells, and topical steroids, such as betamethasone, to reduce the inflammation.
But I wonder if you've been prescribed calcipotriol, a derivative of vitamin D? This has been shown to suppress the cell growth that leads to the build-up of scaly plaques.
A prescription-only treatment, it came on the market in the 1990s and can have startling results, with evidence suggesting it can clear the problem in up to 80 per cent of patients with scalp psoriasis.
Calcipotriol is available in combination with betamethasone as a gel or ointment (such as Dovobet).
A more recent advance is tacrolimus, a drug usually used for transplant patients as an immunosuppressant and as an ointment for the treatment of eczema. It can be prescribed off-licence for psoriasis. Trials have shown it is significantly better than calcipotriol.
I suggest you consult your GP and request a trial of tacrolimus. I hope this helps.
Q: COULD YOU suggest a diet to reverse my weight loss? I have a good appetite but over the past three years my weight has decreased by 28lb - I don't know why. I'm 5ft 10ins and weigh 10st (my BMI is 20). I'm in my 80s.
A: IT IS important that you consult your GP about such significant weight loss to rule out the possibility of an otherwise silent disorder such as an overactive thyroid gland, which can be easily checked for by a blood test.
If this throws up no concerns then my suspicion would be that the cause is age-related loss of muscle - the 'weight' that's being lost is effectively muscle weight.
After middle age, we lose about 3 per cent of muscle each year as it starts to be produced at a slower rate than it is broken down. The way to combat this is through a combination of exercise and diet.
When it comes to exercise, you should aim to be doing three or four sessions of aerobic exercise and resistance training a week - for at least 20 minutes a session.
Resistance training involves weightlifting or the use of resistance bands, while aerobic exercise includes cycling, swimming and even brisk walking.
With diet, the key is getting enough protein - this triggers muscle tissue to build and become stronger but greater amounts are needed when we are older to initiate those signals. The building blocks of proteins are amino acids (found in foods such as meat, fish and eggs).
Omega-3 fatty acids also play a role in muscle growth. The best source is oily fish, and canned fish is a good and inexpensive option.
You could also consider taking a vitamin D supplement. This has been shown to increase muscle strength and reduce the incidence of falls in older people. Ask your pharmacist for advice about the best formulation for you.
If you exercise enough you may gain some weight, but don't obsess about that - your BMI at 20 is still within the healthy range.
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